ASCIA guidelines for prescribing an adrenaline autoinjector. (Additional content – Adrenaline autoinjector (Anapen) for acute allergic anaphylaxis.)

ALWAYS RECOMMENDED

History of anaphylaxis (if patient is considered to be at continuing risk)

Anaphylaxis

A rapidly-evolving, generalised multisystem allergic reaction.

Characterised by one or more symptoms or signs of respiratory and/or cardiovascular involvement and involvement of other systems such as the skin and/or gastrointestinal tract.

Respiratory symptoms

• Difficult/noisy breathing
• Swelling of tongue
• Swelling/tightness in throat
• Difficulty talking and/or hoarse voice
• Wheeze or persistent cough

Cardiovascular symptoms

• Loss of consciousness
• Collapse
• Pale and floppy (in young children)
• Hypotension

SOMETIMES RECOMMENDED

History of a generalised allergic reaction AND one or more risk factors

Generalised allergic reaction

Characterised by one or more symptoms or signs of skin and/or gastrointestinal tract involvement without respiratory and/or cardiovascular involvement.

Skin symptoms

• Generalised pruritus
• Urticaria/angioedema
• Erythema

Gastrointestinal symptoms

• Abdominal pain
• Vomiting
• Loose stools

Risk factors

• Asthma (current or past history)
• Age (children over 5 years, adolescents and young adults)
• Specific allergic triggers:
  — peanut/nut allergy
  — stinging insect allergy in adults (bees, wasps, jumper ants)
• Comorbidity (e.g. ischaemic heart disease)
• Geographical remoteness from emergency medical care

NOT NORMALLY RECOMMENDED

• Asthma with no history of anaphylaxis or generalised allergic reactions
• Elevated specific IgE only (positive RAST and/or skin test) without a history of clinical reactions
• Family (rather than personal) history of anaphylaxis or allergy
• Local reactions to insect stings – in adults and children
• Generalised skin rash (only) to bee or wasp stings – in children
• Resolved food allergy